case report:
44yo female with chronic and constant R sided neck pain with occasional pain in back of head (occiput), occasional HA reto-orbital.
Imaging: mild DDD, otherwise unremarkable
Worse: with work related activities including computer and driving.
Better: stretching-temp relief
Objective:
Observation: flattened c/s curve
Palpation: TrP in post neck and UT. Joint accessory mobility unremarkable
Movement assessment: Functional and nonpainful (FN) cerivcal flexion & BAAR but no carryover, dysfunctional and nonpainful (DN) rotation bilat in standing with worse loss to the R(grossly 45degrees). retraction: BAAR, extension; FN and No effect, SB: no effect Bilat, maybe WAAR.
SFMA breakout in supine showed OA and AA FN and Active rotation FN (grossly 70degr) & passive rotation FN (80degr).
Deep neck flexors testing: weakness noted with difficulty holding and slight c/s extension.
Sp Rest: distraction: + for mild pn relief, compression/spurling/quadrant: all negative
Assessment: motor control deficit for rotation with retraction bias.
Treatment:
Reset: dry needling of the R post neck, R UT and R SCM.
Reinforce: PNF scapular mobility in S/L than repeated retractions. Also added ergo educ with pamphlet focusing on micro work breaks.(save that research for another post)
Reload: cervical rotation + pattern assist, 10xB (given for HEP)
Outcome: Abolishment of all pain and FN c/s rotation bilat especially to R (gross 80degr)
Outcome: Abolishment of all pain and FN c/s rotation bilat especially to R (gross 80degr)
Why This Worked:
One part of motor control dysfunctions could lie in muscle recruitment efficiency, as in the ability for the muscle or a pattern of muscles to be turned on at the right time and at the right intensity. You body regulates this so you don't turn the same muscles for lifting a large bag of groceries as you would for just lifting a fork to your mouth. In fact, according to research from the american journal of sports medicine poor muscle recruitment can have some connections to injuries. In the study, Cools et al demonstrated that those with impingement showed a delay in muscle activation of the middle and lower trapezius muscle.
Therefore, for optimal movement the muscles must be recruited in the optimal muscle activation, or recruitment, pattern. Conversely, improper movement patterns may lead to improper recruitment and resulting pain and dysfunction. Improper patterns may exist due to trigger point in the muscle,as examined by Lucus et al, limiting the range of motion and activation of that muscle. The onset of the trigger points may have occurred form a low threshold onset from computer work for this pt, in which research suggests may only take 1 hour for a trigger point to occur.
The improper muscle activation patterns researched by Lucus et al found motor timing is effected by even trigger points. However, when TrP were resolved, a more normal activation period was seen. Therefore, with needling we can resolve trigger points and their corresponding effects on poor motor activation strategies and then see a big increase in mobility and function. This is done by the needle hitting the trigger point, causing a local twitch that lets the tissue return to its normal resting length. The needle has been shown to:
1. breaks nociceptive input (inhibits the passage of c-fiber action potentials)
2. stops noxious chemical mediators like substance P and bradykinins
3. increases blood flow & oxygen to tissue
4. assist with desensitization
